Asbestos Project Notification Form, DEP Box 39

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ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 1et. (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254 27 This asbestos abatement Is part of a (item a through e requires filing of this form with NYC Department of BuYr rigs) a) 0 Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) ❑✓ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair Of Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) K ~ 0 Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application ~~~ 2) j '//f AV

30. LOCATIONS OF ABATEMENT QooF M ATEei At. : "0(= I4 MBRA NE C Te DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing, room Jt, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e g. running cable, installing fire sprinklers, boiler room, lobby, etc ducts, storsge tanks. deding, etc.) FEET FEET removing and replaang boilers, etc.)

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31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work.

Aon.E►J 4 Pi A►J'LeR eY i1AeE~ Print Name of Air Monitor 1JAMNJ ktJRZSW I Soi Cog Print Name of Asbestos Contractor - Print Name of Applicant (If other than Owner)

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32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein.

io Print Name of Owner ignature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of information provided on this form must be reported immediately in wilting directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened L through the performance of work in incremental or piecemeal fashion. ACP7 212001

NYC-WTC 000111270